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Chiropractic, homeopathy … and more

Skeptical Inquirer, May-June, 2008 by Jay M. Pasachoff, Samuel Homola, Donell Meadows, Julianne Newman, Bruce A. Thyer, Gary Whittenberger, Bruce T. Lowerre

In his chapter on medical cults in Fads and Fallacies in the Name of Science (1957), Martin Gardner discussed chiropractic, osteopathy, and homeopathy. Your January/February 2008 issue has interesting articles about two of these three but no discussion of osteopathy.

The discussion of the third leg of the tripod is important, since doctors of osteopathy (DOs) are now often the only kind of primary care provider that is accessible. My local medical group, for example, just hired two DOs and gave me no access to their surviving MDs on the retirement of my current MD this month. I have been looking elsewhere on the ground that the pseudoscientific beliefs and training of the DOs make me suspicious of everything else they do.

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But I gather that DOs are becoming more mainstream and that they can have good residencies after their osteopathic training. That raises questions as to why they went to osteopathic school instead of medical school in the first place, and what there might be in their training that could lead to nonscientific conclusions as they see patients. Online researching indicates various nonscientific teachings that persist in the osteopathic schools. Under managed care and the pressure of treating patients at a high rate, is it that they act 100 percent like medical doctors (MDs)?

Jay M. Pasachoff

Field Memorial Professor of Astronomy and Director, Hopkins Observatory Williams College

Williamstown, Massachusetts

Author Samuel Homola, DC, replies.

Professor Pasachoff's letter raises important questions and a valid concern. I am not an osteopath and therefore cannot speak authoritatively on the subject of osteopathy. It is my impression, however, that the educational requirements and the training of medical doctors and osteopaths are the same, except that osteopathic schools may include training in manipulative therapy and body mechanics. Some researchers have reported that grade point averages and Medical College Admission Test scores of osteopathic students may be lower than those of medical students.

Since the definition of osteopathy places emphasis on the structural aspects of healing, I'm sure that some well-qualified students of medicine choose to study osteopathic medicine in order to combine the two methods of treatment, reserving use of manipulation (in combination with medical procedures) for treatment of musculoskeletal problems while depending upon medical procedures in the treatment of nonmusculoskeletal problems. An osteopath who combines appropriate use of manipulation with mainstream medical care can offer a valuable and unique service.

Today, the percentage of practicing osteopaths who use manipulative therapy for any reason is low; most are occupied with the practice of medicine. I have no problem with evidence-based osteopaths who include use of manipulative therapy in their treatment armamentarium. Nor do I have a problem with osteopaths who are devoted entirely to medical and surgical procedures. Both can be dependable specialists and primary care providers. But I do understand the concern of persons who question why a qualified pre-med student who is not interested in osteopathic manipulation would choose to attend an osteopathic college rather than a medical college--except for the difficulty of being admitted to an accredited medical college. And one might also wonder if a surgical residency in an osteopathic hospital is equal to residency in a medical hospital.

Unfortunately, it appears that a few osteopaths still cling to the original osteopathic theory, which embraces the idea that osteopathic manipulation can heal disease by removing interference with nerve and blood supply, particularly in the spine. Some of these practitioners may make questionable claims and use such questionable treatment methods as "cranial osteopathy"--claims and methods rejected by mainstream osteopathic and medical practitioners. Graduates of osteopathic colleges that fail to denounce such methods may be less evidence-based than others.

I wanted to pass on to you an experience I had with a friend who is seeing a chiropractor. She was excited about the "doctor" discovering what allergies she had and wanted me to see the woman. This is how this chiropractor tests for allergies: she has the patient hold a metal rod, and then the chiropractor exposes them to an allergen and waits for, as my friend put it, the "histamine reaction." Using this "test" the chiropractor claimed my friend was allergic to soy products and a number of other things. You can imagine her letdown at my lack of interest in contacting the chiropractor to take advantage of her "therapy."

My friend never misses a chance to talk about the chiropractor. But if she thinks I'm going to see someone and pay $150 for small bottles of water that have "memories" and be diagnosed for allergies with a metal rod, she's got another thing coming. Wouldn't this be classified as practicing medicine without a license? Inquiring people want to know.

Chiropractic, homeopathy … and more

Skeptical Inquirer, May-June, 2008 by Jay M. Pasachoff, Samuel Homola, Donell Meadows, Julianne Newman, Bruce A. Thyer, Gary Whittenberger, Bruce T. Lowerre

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